Psychiatric Disorders in Pregnancy

Question 1

List some risk factors for mental illness in pregnant women

Answer 1

Young female
Single mother
Domestic issues
Lack of support
Substance misuse
Unplanned pregnancy
Pre-existing mental illness

Question 2

When should a pregnant patient be referred to psychiatry?

Answer 2

Psychosis
Severe anxiety/depression/suicidal/self-harm
History of bipolar/schizophrenia
History of postnatal psychosis
If on psychiatric medication

Question 3

What is the principle of psychiatric medication treatment in pregnancy?

Answer 3

Low dose monotherapy, taken at increased frequency if need be

Question 4

When should a foetal anomaly scan be carried out in someone pregnant and on psychiatric medication?

Answer 4

16 weeks

Question 5

Breastfeeding should be encouraged whenever possible in psychiatric pregnant patients. True/False?

Answer 5

True
Unless drug toxicity/contraindication

Question 6

Why should benzodiazepines be avoided in pregnancy?

Answer 6

Cause cleft and neonatal withdrawal

Question 7

What is the risk of a baby developing bipolar disorder if a mother has it and is not on treatment?

Answer 7

50%

Question 8

What foetal defects can sodium valproate cause?

Answer 8

Neural tube defects
Craniofacial defects
IUGR
Reduced IQ
Cleft

Question 9

Which mood stabiliser/anticonvulsant is considered safest to use in pregnancy?

Answer 9

Lamotrigine

Question 10

What effects does carbamazepine have on a foetus?

Answer 10

Vitamin K deficiency
Haemorrhagic disease of newborn

Question 11

It is normally ok to breastfeed if you are on an anticonvulsant. True/False?

Answer 11

True

Question 12

What foetal defect can lithium cause?

Answer 12

Ebstein’s anomaly

Question 13

Is lithium contraindicated in breastfeeding?

Answer 13

Yes

Question 14

Which antipsychotics - typical or atypical - are generally safe to use in pregnancy?

Answer 14

Typicals

Question 15

Which antipsychotic is contraindicated in pregnancy because of its liability to induce life-threatening events in an infant?

Answer 15

Clozapine

Question 16

Can anticholinergic drugs be used in pregnancy?

Answer 16

No

Question 17

Which antidepressant can cause cardiac abnormalities in an infant?

Answer 17

Paroxetine

Question 18

All antidepressants can cause withdrawal and toxicity in neonates. True/False?

Answer 18

True
Usually self-limiting though

Question 19

When does postnatal depression typically onset?

Answer 19

2-6 weeks postnatally

Question 20

List clinical features of postnatal depression

Answer 20

Anxiety, tearfulness
Lack of enjoyment
Poor sleep
Concerns re baby

Question 21

How does postnatal depression differ from “baby blues”?

Answer 21

Baby blues is more brief and self-limiting

Question 22

List clinical features of puerperal psychosis

Answer 22

Sleep disturbance
Confusion
Delusions, hallucinations
Irrational ideas
Mania

Question 23

Puerperal psychosis is an emergency. True/False?

Answer 23

True
Needs urgent admission to mother-baby unit

Question 24

List features of foetal alcoholic syndrome

Answer 24

Facial deformity
Lower IQ
Neurodevelopmental delay
Epilepsy
Hearing defect
Cardiac + renal defects

Question 25

What should be considered management-wise if substance abuse is occurring in pregnancy?

Answer 25

Methadone programmes
Social work/child protection
Labour planning
Postnatal plan